Connecting complex networks to nonadditive entropies

Boltzmann–Gibbs statistical mechanics applies satisfactorily to a plethora of systems. It fails however for complex systems generically involving nonlocal space–time entanglement. Its generalization based on nonadditive q-entropies adequately handles a wide class of such systems. We show here that scale-invariant networks belong to this class. We numerically study a d-dimensional geographically located network with weighted links and exhibit its ‘energy’ distribution per site at its quasi-stationary state. Our results strongly suggest a correspondence between the random geometric problem and a class of thermal problems within the generalised thermostatistics. The Boltzmann–Gibbs exponential factor is generically substituted by its q-generalisation, and is recovered in the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$q=1$$\end{document}q=1 limit when the nonlocal effects fade away. The present connection should cross-fertilise experiments in both research areas.

Pixantrone anticancer drug as a DNA ligand: Depicting the mechanism of action at single molecule level

In this work we use single molecule force spectroscopy performed with optical tweezers in order to characterize the complexes formed between the anticancer drug Pixantrone (PIX) and the DNA molecule, at two very different ionic strengths. Firstly, the changes of the mechanical properties of the DNA-PIX complexes were studied as a function of the drug concentration in the sample. Then, a quenched-disorder statistical model of ligand binding was used in order to determine the physicochemical (binding) parameters of the DNA-PIX interaction. In particular, we have found that the PIX molecular mechanism of action involves intercalation into the double helix, followed by a significant compaction of the DNA molecule due to partial neutralization of the phosphate backbone. Finally, this scenario of interaction was quantitatively compared to that found for the related drug Mitoxantrone (MTX), which binds to DNA with a considerably higher equilibrium binding constant and promotes a much stronger DNA compaction. The comparison performed between the two drugs can bring clues to the development of new (and more efficient) related compounds.

Vascular endothelial growth factor concentrations in the serum and peritoneal fluid of women with endometriosis

OBJECTIVES

To investigate whether there is an association between vascular endothelial growth factor (VEGF) levels in serum and peritoneal fluid, and the presence of pelvic endometriosis and its clinical symptoms.

METHODS

Blood and peritoneal fluid sample levels of VEGF were measured in 46 women undergoing laparoscopy: 32 with suspected endometriosis and 14 with confirmed endometriosis. Data were analyzed according to phase of the menstrual cycle, symptoms, disease stage, and disease site.

RESULTS

There were no significant associations between serum and peritoneal fluid levels of VEGF and the presence of endometriosis, even when controlling for the menstrual phase. However, among the women with confirmed endometriosis, there was a significant increase (P=0.002) in the mean peritoneal VEGF level in those in the late secretory phase compared with those in the proliferative and early secretory phases.

CONCLUSIONS

Measuring VEGF levels in symptomatic patients is not helpful to differentiate those with endometriosis from those with a different condition. However, in the late secretory and menstrual phases, mean VEGF levels were higher in women with confirmed endometriosis than in those suspected of having the disease.

Endometriosis: an inflammatory disease with a Th2 immune response component

BACKGROUND

Efforts have been made to correctly characterize the role of the immune response in endometriosis. The objective of this study was to analyse the interaction between Th1 and Th2 immune response patterns and endometriosis by evaluating a panel of cytokines.

METHODS

Between January 2004 and November 2005, 98 patients, classified into two groups according to the histologically confirmed presence (Group A) or absence of endometriosis (Group B), were evaluated. Interleukins (IL) 2, 4 and 10, tumour necrosis factor-alpha and interferon-gamma (IFN-gamma) were measured by flow cytometry in the peripheral blood and peritoneal fluid of all patients.

RESULTS

IFN-gamma and IL-10 levels were significantly higher in the peritoneal fluid of patients with endometriosis compared to those without endometriosis (P < 0.05). There was a significant alteration in the IL-4/IFN-gamma (P < 0.001), IL-4/IL-2 (P = 0.006), IL-10/IFN-gamma (P < 0.001) and the IL-10/IL-2 ratios (P < 0.001) in the peritoneal fluid of patients with endometriosis, with a predominance of IL-4 and IL-10, reflecting a shift towards Th2 immune response despite the increase in IFN-gamma concentrations.

CONCLUSIONS

Endometriosis is an inflammatory disease involving a possible shift towards Th2 immune response component, as demonstrated by the relative increase in cytokines characteristic of this pattern of immune response.

Serotypes of carriage and invasive isolates of Streptococcus pneumoniae in Brazilian children in the era of pneumococcal vaccines

Nasopharyngeal carriage of Streptococcus pneumoniae is a key factor in the development of invasive disease and the spread of resistant strains within the community. A single nasopharyngeal swab was obtained from 648 unvaccinated children aged <5 years, either healthy or with acute respiratory tract infection or meningitis, during the winters of 2000 and 2001. The overall pneumococcal carriage rate was 35.8% (95% CI 32.1-39.6). The pneumococcal serotypes found most frequently in the nasopharynx were 14, 6B, 6A, 19F, 10A, 23F and 18C, which included five of the seven serotypes in the currently licensed seven-valent conjugate vaccine (PCV7); serotypes 4 and 9V were less common. Serotypes 1 and 5 were isolated rarely from the nasopharynx. A comparison of 222 nasopharyngeal isolates with 125 invasive isolates, matched for age and time to the carrier isolates, showed a similar prevalence of penicillin non-susceptible pneumococci (PNSp) (19.8% and 19.2%, respectively). PNSp serotypes were similar (6B, 14, 19F, 19 A, 23B and 23F) for carriage and invasive disease isolates. The coverage of PCV7 for carriage isolates (52.2%) and invasive isolates (62.4%) did not differ significantly (p 0.06); similarly, there was no significant difference in PCV7 coverage for carriage isolates (34.5%) and invasive isolates (28.2%) of PNSp. These data suggest that PCV7 has the potential to reduce pneumococcal carriage and the number of carriers of PNSp belonging to vaccine serotypes.

[Living conditions and life experiences of working-class groups in Rio de Janeiro: rethinking dengue control and popular mobilization]

Using narratives of an experience with popular mobilization during the 1986-91 dengue epidemic in the city of Rio de Janeiro, the authors discuss the scientific research and technical counseling involving basic sanitation conditions for vulnerable social groups. They present research results on water distribution in the slums from the Leopoldina area of the city. The research stemmed from demands by community leaders at local forums discussing health conditions. Gathering, systematizing, and analyzing the data were based on what they call "shared knowledge construction", resulting by crossing accumulated scientific knowledge with popular knowledge produced as a result of living conditions and life experiences among working-class groups. Finally, the authors comment on the need for local health professionals to be aware of relationships between epidemic and endemic processes and protection of life.

Mandibular flexure and dental implants: a case report

The mandibular deformation as a result of jaw movement from rest position has been studied and documented by other authors. Here, we report that there is a possible correlation between this phenomenon and the discomfort experienced by a patient rehabilitated with implant-supported restoration for the mandibular arch during function. The recovery from pain and symptoms was achieved only after splitting the prosthesis into three sections. This case report serves to remind clinicians of the importance of following biological concepts as the key to a successful result.

Differences in Brazilian strains of Schistosoma mansoni evaluated by means of morphometric analysis of cercariae of both sexes

Morphometrics of Brazilian strains (BH, SJ and CMO) of Schistosoma mansoni cercariae were obtained with a computerized image analyzer (IMAGE PRO PLUS, MEDIA CYBERNETICS), considering the following characters: body area, tail, furcae, oral and ventral suckers and distance between them. For statistical analysis, the variance test (one-way Anova) was applied and significant differences of p< 0.05 were considered. All morphometric values in the BH strain were significantly higher (p< 0.05) than in the others. Lower values were obtained in females of SJ strain for all characters, excepting the body area. Only this character showed to be significantly different in males and females of the three strains. Specimens of both sexes in the BH and SJ strains showed significant differences regarding all characters. It was observed that this morphometric analysis permits the characterization of strains and also the sex identification in S. mansoni cercariae. Due to its feasibility, this method can be applied as a tool in laboratories devoid of more complex equipment.

Expression of neuronal nitric oxide synthase mRNA in stress-related brain areas after restraint in rats

The objective of the present study was to investigate the expression of neuronal nitric oxide synthase (nNOS) mRNA in stress-related areas after restraint. Male Wistar rats (n=4-6/group) submitted to 2 h of restraint during one (acute) or seven (chronic) days were sacrificed 24 h after the last restraint period. In situ hybridisation was performed with oligonucleotide probes radiolabeled with (35)S. Acute restraint induced a significant increase in nNOS mRNA in the paraventricular hypothalamic nucleus (PVN), medial parvocellular part, dorsolateral periaqueductal grey (DLPAG) and medial amygdaloid nucleus, but not in the hippocampal formation. This effect persisted after chronic restraint in the PVN and DLPAG. These results suggest that restraint stress induces changes in gene expression of nNOS in areas related to stress reactions.

Tumor markers in endometriosis

OBJECTIVES

The objective of the present study was to determine the concentrations of CA 125, CA 15-3, CA 19-9, carcioembryogenic antigen (CEA), alpha-fetoprotein (AFP) and beta-2 microglobulin (B2MG) in patients with pelvic endometriosis.

METHOD

Fifty women were divided into two groups: group A (control) had no endometriosis or other diseases, and group B consisted of 35 women with pelvic endometriosis. All women were submitted to serum determination of CA 125, CA 15-3, CA 19-9, CEA, AFP and B2MG. Samples were collected during the menstrual cycle and 1 week later.

RESULTS

Mean CA 125 concentrations were altered in patients with endometriosis, but all 50 patients studied presented normal CEA, AFP and B2MG concentrations. Small variations detected in CA 19-9 and CA 15-3 had no statistical significance.

CONCLUSION

CA 125 is the only important marker in the diagnosis of stages III/IV of endometriosis, especially when blood samples for its determination are obtained during the first 3 days of the menstrual cycle.

Schistosoma mansoni Sambon, 1907: morphometric differences between adult worms from sympatric rodent and human isolates

A computer software for image analysis (IMAGE PRO PLUS, MEDIA CYBERNETICS) was utilized in male and females adult worms, aiming the morphological characterization of Schistosoma mansoni samples isolated from a slyvatic rodent, Nectomys squamipes, and humans in Sumidouro, Rio de Janeiro, Brazil and recovered from Mus musculus C3H/He. The following characters for males's testicular lobes were analyzed: number, area, density, larger and smaller diameter, longer and shorter axis and perimeter and extension; for females: area, longer and shorter axis, larger and smaller diameter and perimeter of the eggs and spine; oral and ventral suckers area and distance between them in both sex were determined. By the analysis of variance (one way ANOVA) significant differences (p < 0.05) were observed in all studied characters, except for the density of testicular lobes. Significant differences (p < 0.05) were detected for all characters in the female worms. Data ratify that sympatric isolates present phenotypic differences and the adult female characters are useful for the proper identification of S. mansoni isolates.

[Dengue in Rio de Janeiro: rethinking popular participation in health]

This paper discusses popular participation in health from the point of view of an experience in dengue epidemic control in the late 1980s and early 1990s in the city of Rio de Janeiro. It refers specifically to a social movement called "Se Liga, Leopoldina", combining professionals (from health services and public schools) and members of popular organizations from the suburban neighborhoods served by the Leopoldina railway. The paper reviews the ideas motivating actions undertaken by the movement, principally the role of popular organizations in the control of endemics. It calls attention to the danger of preconceived notions when analyzing participation by members of popular organizations in the social movement. The author also calls attention to the fact that social scientists researching social movements should focus on being part of a wider social network of conviviality rather than seeing their role as educating members of the popular organization. Such networks should seek to strengthen and expand social support for the endemic control process.

Central nervous system metastases from breast carcinoma. A clinical and laboratorial study in 47 patients

In this retrospective study, 47 patients with clinical diagnosis of central nervous system metastases of breast cancer were evaluated by computerized tomography (CT), magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. The patients were divided in 2 groups: 1, without leptomeningeal neoplasm and 2, with leptomeningeal neoplasm. In the group 2, the time interval between the primary disease and the central nervous system metastasis as well as the survival time were shorter than in group 1 (40 and 4.3 months in group 2 versus 57 and 10 months respectively, in group 1). In both groups the most common neurological symptoms and signs were intracranial hypertension and motor deficits. The most sensitive diagnostic methods were CT and MRI in group 1, and the CSF examination in group 2. The use of the tumor markers CEA and CA-15.3 in the routine examination of CSF showed promising results, mainly in leptomeningeal forms.

Highly sensitive single-step PCR protocol for diagnosis and monitoring of human cytomegalovirus infection in renal transplant recipients

A multiplex, single-step PCR protocol for the detection of human cytomegalovirus (HCMV) DNA is described. The protocol amplifies regions of the viral LA and IE genes and employs elevated temperatures for both reagent mixing and primer annealing together with product detection by silver staining on polyacrylamide gels. This assay detects one to five HCMV genomes in clinical samples containing up to 100 ng of human DNA, a level of sensitivity equivalent to that of more complex assays involving either nested PCR or postamplification hybridization. As well as being of importance in clinical situations where high-sensitivity qualitative diagnosis is required, this assay is also applicable to the monitoring of HCMV infection in renal transplant recipients. Due to its multiplex format the assay provides quantitative information, in that samples from which a single target is amplified contain on average sevenfold fewer viral genomes per 10(6) leukocytes than those from which both targets are amplified. When weekly blood leukocyte DNA preparations from renal transplant patients were assayed, findings of three consecutive tests in which both HCMV targets were amplified were highly indicative of patients who had developed very high loads of HCMV (100% sensitivity, 88% specificity). We thus show that the same simple PCR assay which permits highly sensitive HCMV diagnosis can also be used for the efficient identification of transplant recipients at risk of clinically significant infection.

The use of biochemical markers in the diagnosis of pelvic endometriosis

The aim of this study was to evaluate CA 125 II, C-reactive protein (CRP) and serum amyloid A (SAA) and anticardiolipin antibody (aCL) concentrations for the diagnosis of pelvic endometriosis. The study population consisted of 15 women without endometriosis, as confirmed by laparoscopy (group A), and 35 patients with pelvic endometriosis diagnosed by laparoscopy or laparotomy (group B). Group B patients were divided into those at stages I and II of the disease (BI/II) and those at stages III and IV (BIII/IV). Blood samples were obtained twice during the menstrual cycle: on day 1, 2 or 3 of the cycle and on day 8, 9 or 10 of the cycle. CA 125 II and CRP concentrations were higher in group III/IV patients compared with healthy controls, mainly during the first 3 days of the menstrual cycle; SAA concentrations were also higher in this group of patients compared with healthy controls, but only during the first 3 days of the menstrual cycle. Immunoglobulin (Ig) M aCL concentrations were higher in all patients with endometriosis compared with healthy controls, mainly during the first 3 days of the menstrual cycle. It is concluded that these determinations may contribute to the diagnosis and the indication of treatment for pelvic endometriosis. Determination of CA 125 II concentrations at the beginning of the menstrual cycle may aid the diagnosis of stage III and IV endometriosis. IgM aCL appears to be associated with the presence of all stages of the disease, while SAA values are elevated in severe situations. Measurement of these molecules may therefore provide a valuable tool in the diagnosis and management of endometriosis.

[Anti-beta-2-microglobulin antibodies in systemic lupus erythematosus]

The aim of this work was the study of 88 patients with SLE for clinical, laboratorial and demographical parameters. The patients sera were assayed for the presence of anti-beta-2-microglobulin antibodies by ELISA. These spectrofotometric results were converted in a standard-deviation unity in relation to the average of 29 control individuals values. It was established a cut-off of 2.5 standard-deviation in order to determine the limit of normality as well as the cut-off of 10 standard deviation was chosen in order to defined the higher values. Several statistical significant associations were observed between the anti-beta-2-microgobulin and the clinical and laboratorial parameters. The clinical applications of those associations were determined by the predictive value. It was only considered the values greater then 75%. The negative predictive values found in the lower cut-off were 92% to ANA (homogeneous-peripheral pattern), 89% to high levels CIC, 81% to mucocutaneous vasculitis and 80% to depressed CH50 levels. The positive predictive values found in 88% to high level of mucoprotein, 83% to mucocutaneous vasculitis, 83% to the onset-disease-time lower six years and 78% to limphopenia. Special attention may be paid to the high sensibility and specificity of the anti-beta-2-microglobulin test to some of the parameters in the evaluation of the disease activity, mainly in mucocutaneous vasculitis.

Randomised trial of efficacy of benznidazole in treatment of early Trypanosoma cruzi infection

BACKGROUND

Benznidazole, a nitroimidazole derivative, has been recommended for the treatment of acute and congenital Trypanosoma cruzi infection (Chagas' disease). We have examined the safety and efficacy of this drug in the treatment of the early chronic phase of T cruzi infection.

METHODS

Between 1991 and 1995, we carried out a randomised, double-blind, placebo-controlled trial in a rural area of Brazil with endemic Chagas' disease. 82% of 2434 schoolchildren (aged 7-12 years) identified in a census were screened for antibodies to T cruzi by indirect immunofluorescence, indirect haemagglutination, and ELISA. 130 were positive in all tests and were randomly assigned benznidazole (7.5 mg/kg daily for 60 days by mouth) or placebo. The primary endpoint for efficacy was the disappearance of specific antibodies (negative seroconversion) by the end of 3-year follow-up. The secondary endpoint was the reduction of antibody titres on repeated serological tests. One child moved away from the area just after randomisation and was excluded from the analyses. Insecticidal measures were taken throughout the trial to reduce the risk of reinfection.

FINDINGS

Minor side-effects requiring no specific medication were recorded in a small proportion of individuals. On a chemiluminescent ELISA with purified trypomastigote glycoconjugate, serum from all participants was positive at the beginning of the trial. At the end of follow-up, 37 (58%) of the 64 benznidazole-treated participants and 3 (5%) of those who received placebo were negative for T cruzi antibodies. The efficacy of benznidazole treatment estimated by intention to treat was 55.8% (95% CI 40.8-67.0). At the end of follow-up, children who received benznidazole had five-fold lower geometric mean titres by indirect immunofluorescence than placebo-treated children (196[147-256] vs 1068[809-1408], p < 0.00001).

INTERPRETATION

The trial showed that a 60-day course of benznidazole treatment of early chronic T cruzi infection was safe and 55.8% effective in producing negative seroconversion of specific antibodies. The results are very encouraging and justify the recommendation of treatment for seropositive children as public health policy.

Schistosoma mansoni Sambon, 1907: comparative morphological studies of some Brazilian strains

The morphology of Schistosoma mansoni adult male worms from three strains which have been maintained in albino mice for several generations, was compared to a strain that has been isolated from the natural host Nectomys squamipes (Rodentia:Muridae) captured in Sumidouro (Rio de Janeiro State) and have been maintained in the same sylvatic rodent under laboratory conditions. Total length of specimens, distance between suckers, the number of testes and extention of testes grouping were the taxonomic characters analysed. The worms recovered from N. squamipes showed expressive differences (p < 0.01) compared to the other strains regarding the considered morphological characters. The strains that were maintained in mice presented statistical differences (p < 0.01) in several characters. Some adult worms besides the normal position of the testes also showed an atypical arrangement of these glands. It can be concluded that the morphology of adult worms may be used to distinguish S. mansoni strains and that morphological changes in adult worms are not induced by successive inoculations of a strain in mice.

[Immunological parameters in the differential diagnosis of ascites secondary to peritoneal carcinomatosis, hepatic cirrhosis, and congestive heart failure]

As a contribution to the study of ascites in patients with liver cirrhosis, congestive heart failure and peritoneal carcinomatosis evaluate in serum and ascites the concentrations of alphafetoprotein, carcinoembryonic antigen and fibronectin, they might suggest a diagnosis for the basic pathology. Forty-seven patients were studied, from whom 23 with cirrhosis, 17 peritoneal carcinomatosis and 7 with congestive heart failure. We conclude that: a) none of the tools usually employed in the analysis of ascitic fluid alone can make the base pathological process responsible for producing ascites; b) fibronectins were more useful for differential diagnosis between cirrhosis and carcinomatosis; c) alpha-fetoprotein and carcinoembryonic antigen were not useful for the definition for differential diagnosis.

[Wild rodents as experimental models of schistosomiasis mansoni: Akodon arviculoides (Rodentia: Cricetidae)]

The experimental infection of A. arviculoides through different routes of penetration of Schistosoma mansoni cercariae (Transcutaneous and subcutaneous) was studied by the kinetics of egg elimination in stools, by the recovery and localization of adult worms (in the portal system and the mesenteric veins) and through the quantitative egg count. It was shown that A. arviculoides infection is similar to the albino mice which served as control in relation to the efficiency of penetration routes, to the adult worms habitat and the egg count. These results suggest that other aspects of the host-parasite relationship should be evaluate so that A. arviculoides may be indicated as an alternative experimental model in schistosomiasis studies.

Complement activation by anticardiolipin antibodies

A haemolytic assay was used to test the complement fixation ability of 16 serum samples with high concentrations of anti-cardiolipin antibodies. Fourteen patients had clinical complications usually associated with these antibodies--namely, recurrent abortions, thrombosis, or thrombocytopenia. Complement fixation by anticardiolipin antibodies was shown in only four of these patients and was not directly related to the antibody concentration. Because anticardiolipin antibodies in most of these patients did not activate the complement pathway it is unlikely that the complement cascade has an important role in the clinical complications associated with these antibodies.

Microinjection of propranolol into the dorsal periaqueductal gray causes an anxiolytic effect in the elevated plus-maze antagonized by ritanserin

The 5-HT1A/1B receptor antagonist propranolol was injected into the dorsal periaqueductal gray (DPAG) of rats exposed to the elevated plus-maze in order to investigate the participation in anxiety of 5-HT mechanisms operating in this brain region. Microinjection of D,L- or L-propranolol into the DPAG increased the percentage of total arm entries without affecting the total number of entries into either open or enclosed arms of the maze, an effect characteristic of anxiolytic drugs injected systemically. The doses of 5 nmol L-propranolol and 10 nmol D,L-propranolol caused anxiolytic effects of comparable magnitude, while the doses of 2.5 nmol of the former and 5 nmol of the latter were ineffective. Therefore, the L-isomer is likely to be the main one responsible for the pharmacological activity observed. In addition, the anxiolytic effect of 10 nmol D,L-propranolol was antagonized by 10 nmol of the 5-HT2/1C receptor antagonist ritanserin, previously injected into the DPAG. The present as well as previously reported results suggest that the anxiolytic effect of propranolol injected into the DPAG is due to increased release of 5-HT acting on post-synaptic 5-HT2 receptors, resultant from blockade of 5-HT1B autoreceptors that inhibit amine release from serotonergic nerve endings.

Neuropsychiatric manifestations of systemic lupus erythematosus: the value of anticardiolipin, antigangliosides and antigalactocerebrosides antibodies

In an attempt to find a serological marker for neuropsychiatric manifestations (NPM) of SLE, sera from 66 patients (classified in three groups, according to their NPM-defined, probable and without NPM) were analysed by ELISA for IgG and IgM anticardiolipin, antigangliosides and antigalactocerebrosides antibodies. A strong correlation was found between IgM antigangliosides and antigalactocerebrosides antibodies and NPM, but not with IgG class. IgM and IgG antibodies anticardiolipin were not correlated with NPM in this study. Both IgM antigangliosides and antigalactocerebrosides antibodies disappeared in seven patients with definite but clinically inactive NPM. The analysis of these autoantibodies showed an important role predictive for NPM in SLE; the negative test decreases the chance of the NPM.

Mycobacterial subcutaneous arteritis

The authors report three patients with subcutaneous erythematous nodules in different phases of development, unspecific systemic symptoms, positive PPD test, and normal chest X-rays. The histopathological study of the older nodules showed a granulomatous arteritis with a few acid-fast bacilli in the vascular wall. The nodules at an early phase showed an unspecific panniculitis with some acid-fast bacilli in apparently normal cutaneous vessels. These findings suggest that the mycobacterium has a vascular tropism and may cause a primary granulomatous arteritis.

Epidermal nuclear immunoglobulin deposition in connective tissue diseases

Epidermal nuclear deposition of immunoglobulins (in vivo ANA) was observed in 45 out of 252 skin biopsies (17.8%). It occurred in 19% of cases with systemic lupus erythematosus, in 32% of the mixed connective tissue disease, in 22% of the scleroderma, in 20% of the cutaneous vasculitis, in 18% of the polymyositis, in 33% of the Sjogren's syndrome, but it was absent in cases with rheumatoid arthritis. The in vivo ANA showed a significant association with serum antibodies to an extractable nuclear antigen (ENA), with speckled pattern of immunofluorescent antinuclear antibody (FANA) and with antibody to a fraction of ENA sensitive to ribonuclease termed ribonucleoprotein (RNP). Indirect evidence was obtained suggesting that the epidermal nuclear deposition of immunoglobulins is a true in vivo phenomenon: some patients with serum antibodies to ENA do not display in vivo ANA and contrariwise, no difference was detected between diseased and normal skin for the occurrence of in vivo ANA and also no association was observed between this phenomenon with immune deposits at dermoepidermal junction or in subepidermal vessels.

Anticardiolipin antibodies and disease activity in systemic lupus erythematosus

We studied a group of 80 unselected patients with systemic lupus erythematosus (SLE). Twenty six (32.5%) of them were considered in clinical activity using criteria based on clinical features and laboratory abnormalities. Using an isotype specific enzyme linked immunosorbent assay (ELISA) for anticardiolipin antibodies we found IgG anticardiolipin in 28/80 (35%) and IgM anticardiolipin in 20/80 (25%) patients. Antibodies to native DNA by immunofluorescence were found in 11/80 (14%) patients, whereas antibodies to denatured DNA by ELISA were found in 51/80 (64%) patients. There was an association between disease activity and the presence of anticardiolipin and anti-DNA antibodies particularly of the IgG isotype. We also found an association between anticardiolipin and anti-DNA suggesting a cross reaction between these antibodies, but we are not able to exclude the possibility of a simple coincidental phenomenon due to polyclonal synthesis of immunoglobulin observed during periods of disease activity.

Neuroleptic-associated autoantibodies. A prevalence study

Antinuclear antibodies (ANA), antiphospholipid antibodies (APA), rheumatoid factor (RF), and immunoglobulin (Ig) M levels were determined in 184 male chronic psychiatric patients on long-term therapy with neuroleptics, and in 35 age-matched normal male controls. The prevalence of one or more of these autoantibodies was 70% in the neuroleptic-treated patients and 9% in the normal controls. Polyclonal IgM elevation was frequently seen among patients treated with phenothiazines. There was a significant correlation between the presence of ANA, APA, and RF; ANA and APA were more frequently associated with CPZ therapy, but the prevalence of RF was high in all treatment groups. These findings suggest that antibodies against the Fc fragment of IgG are the most common autoantibody associated with neuroleptics. Alternatively, the presence of RF could be a common finding in patients with neuropsychiatric disorders.

[Clinical and biochemical characterization of isoniazid-induced auto-antibodies]

Isoniazid (INH) is one among many drugs capable of inducing autoantibodies and, in some cases, a lupus-like syndrome (LE). A longitudinal study was performed in 24 tuberculosis patients treated with INH to detect antibodies (A-AH) to total histones and fractions. Antinuclear antibodies were observed in two patients after treatment. Higher frequency of IgM-AH was also observed. IgM-AH binding to all fractions were observed in those serum samples exhibiting stronger ELISA reactivity. Conversely, binding to only H1 occurred when lower IgM-AH activity was tested. Correlations with clinical expressions of LE were not observed in the present study.

Anticardiolipin antibodies in patients with rheumatoid arthritis

Anticardiolipin antibodies (ACA) were assayed by ELISA in 73 patients with rheumatoid arthritis. Twelve (16.48%) patients showed levels of ACA three standard deviations above the value of the control group and were considered positive; these patients were compared to the group with ACA within the normal levels regarding the following clinical and laboratorial characteristics: spontaneous abortions, central nervous system involvement, systematization and activity of disease, alterations in platelet counts, presence of antinuclear antibodies and rheumatoid factor. Significant statistical association could be demonstrated between systematization and presence of antinuclear antibodies (ANA) and positiveness to ACA (IgG, IgM or both). These findings might indicate that ACA in patients with RA could have relevance to morbidity of disease or perhaps to its pathogenesis.

Acetylcholine receptor antibody in myasthenia gravis

Radioimmunoassay techniques were used to detect antibodies to the acetylcholine receptor (AAChR) in 164 patients with adult-onset myasthenia gravis. AAChR levels above 0.6 nM/l were considered pathological and were found in 67% of the patients with an average value of 58.99 +/- 125.02 nM/l (0.6-900.0). Correlation, with clinical functional status, the histopathological thymus alterations and the different therapeutics used did not disclose any statistically significant differences.

[Autoantibodies in the diagnosis of autoimmune diseases of the liver]

In recent years a considerable knowledge concerning the use of autoantibodies as diagnostic markers in clinical hepatology, has been accumulated. The present article reviews the most important autoantibodies such as anti-smooth muscle, antimicrosomal of the liver and kidney, antimitochondria and antinuclear antibodies.

Nervous system involvement in systemic lupus erythematosus: report of three cases

Central nervous system involvement in systemic lupus erythematosus is rather frequent whereas peripheral nervous system involvement is much less common. The three patients studied by us had isolated manifestations uncommon in nature. The first one developed a sensory-motor polineuropathy with signs of axonal degeneration. It responded to the therapeutic association of corticosteroids with an immunosuppressive agent. Satisfactory recovery took place over a time span of a year. The second patient had encephalic and cerebral trunk involvement from which an irreversible dementia resulted. The third patient, who had recurrent aseptic meningitis, is asymptomatic for six months now. Patients one and two had no systemic manifestations at the time of nervous system involvement. Suspicion of systemic lupus erythematosus was made on the basis of past inspecific articular symptoms. The neurological and systemic manifestations may be sometimes simultaneous; they are usually followed by serologic changes. Isolated nervous system involvement may be seen with and without sorologic changes, and there may be found antibodies reactive with phospholipids (anticardiolipin, antigangliosides and anticerebrosides). The employment of nonsteroid immunosuppressive drugs associated with corticosteroids in small doses seems to be useful in cases of systemic lupus erythematosus with nervous system involvement.

Anticardiolipin antibodies in Behçet's syndrome: a predictor of a more severe disease

A high incidence of anticardiolipin antibodies were detected in 7 of 20 patients (35%) with Behçet's Syndrome. Three patients had IgG-ab, three had IgM-ab and one had both IgG and IgM antibodies. IgG-ACA was detected mainly in patients with ocular disease (30%) and one of them also has cerebral vascular disease. A lower incidence of ACA was found in the patients taking steroids compared with the ones taking other drugs. This work draws attention to the more severe disease present in patients with ACA and also the possibility of such tests become negative in patients taking immunosuppressive drugs.

Association of anti-DNA and anticardiolipin antibodies in systemic lupus erythematosus

Recent studies have shown that anti-DNA and anticardiolipin antibodies in patients with SLE may cross-react. Using an ELISA for determination of these antibodies, a strong association between IgG anti-denatured DNA and IgG anticardiolipin antibodies was found. Eight sera samples with the highest levels of both antibodies were selected to determine the possibility of a cross-reaction. The levels of anticardiolipin were not affected by denatured DNA in concentrations adequate to inhibit the anti-DNA binding. These data did not confirm previous studies using monoclonal antibodies showing cross reactivity between the two groups of antibodies. Nevertheless, a population of antibodies that may cross-reacts, in some special cases, cannot be ruled out.

Chlorpromazine-induced anticardiolipin antibodies and lupus anticoagulant: absence of thrombosis

Anticardiolipin antibodies were determined in 96 psychiatric patients treated chronically with chlorpromazine by an enzyme-linked immunosorbent assay using anti-IgM and anti-IgG (fab'2 fragment) as the second antibody. Fifty-four of these patients had an IgM-lupus anticoagulant, and the remaining 42 were followed as controls. Elevated IgM-anticardiolipin antibodies (ACA) levels were detected in 31 patients with the lupus anticoagulant and in 5 controls (p less than 0.001). During a median followup of 5 years, single episodes of deep vein thrombosis or pulmonary embolism occurred in three patients; one had the lupus anticoagulant and the other two had low-level ACA. Contrary to the reported experience in systemic lupus erythematosus and related autoimmune disorders, chlorpromazine-induced lupus anticoagulant and anticardiolipin antibodies levels appear not to be associated with an increased incidence of thrombosis.

Antibodies to collagen in experimental antigen induced arthritis of the rabbit

Fifteen rabbits with antigen (bovine serum albumin) induced arthritis had antibodies to collagens type I, II and III detected weekly by passive hemagglutination. Antitype I collagen antibodies were detected in 80% of the animals in the 3rd week of arthritis; antitypes II and III were found less frequently. No anticollagen antibody was detected after the 6th week of arthritis. Although the appearance of these antibodies was clearly related to the induction of arthritis, results indicate that humoral immunity to collagen is unable to initiate or contribute to the perpetuation of synovitis in this experimental model. Antibodies to collagen are probably an epiphenomenon of articular damage in the antigen induced arthritis of the rabbit.

[Dermatopolymyositis: evaluation of 63 patients]

Sixty-three patients with dermatopolymyositis were evaluated from the clinical, laboratory and therapeutical aspects during a period of 15 years: 39 are women and 24 men. The mean age was 36.8 +/- 15.6 years. No correlation was observed between clinical and isolated therapeutics employed; when corticosteroids and cytolytic drugs were used simultaneously, the clinical response was satisfactory. No special fact was seen that can predict the therapeutical response.

Characterization and antigenic specificity of chlorpromazine-induced antinuclear antibodies

Prolonged treatment with chlorpromazine is often associated with the development of antinuclear antibodies, an immunoglobulin M lupus anticoagulant, and polyclonal serum IgM elevation, but not with clinical features of systemic lupus erythematosus (SLE). Sera from 62 long-term psychiatric patients given treatment daily with 100 mg or more of chlorpromazine for at least 1 year were screened for antinuclear antibodies by indirect immunoperoxidase assay using HEp-2 cells. In 26 samples, antinuclear antibody titers greater than or equal to 1:40 with a homogeneous pattern were seen when anti-human IgM was used as the second antibody, three sera samples reacted with IgG, and four samples reacted with both IgG and IgM antisera. The antinuclear antibody antigenic reactivity was investigated by using histone and nonhistone nuclear antigens by enzyme-linked immunosorbent assay and passive hemagglutination techniques. Forty serum samples reacted with histone. Twenty-five samples reacted with deoxyribonucleoprotein (DNP), 28 with single-stranded DNA, and two with double-stranded DNA. No reaction was obtained with the extractable nuclear antigens RNP or Sm. These results indicate that chlorpromazine-induced antinuclear antibodies, like the antinuclear antibodies induced by hydralazine and procainamide, react mainly with histone nuclear antigens. Unlike the hydralazine and procainamide response, in which both IgG and IgM antibodies are demonstrated, the chlorpromazine-induced autoantibodies are predominantly of the IgM class.

A phase I clinical trial of Fansimef (mefloquine plus sulfadoxine-pyrimethamine) in Brazilian male subjects

A double-blind, randomized phase I clinical trial was carried out to compare Fansimef (a fixed-dose combination of mefloquine, sulfadoxine, and pyrimethamine) with sulfadoxine and pyrimethamine (Fansidar) for safety and tolerance. Twenty adult male Brazilian subjects from malaria endemic areas were studied for a period of 66 days, which included 2 days before and 63 days after drug administration.Both drugs were well tolerated and safe, as seen from the absence of drug-induced changes in the various laboratory, haematological, and biochemical parameters measured. Fansimef produced a complete clearance of parasites on day 3, with an "S" type response in one subject who had blood smears which were positive for Plasmodium falciparum on day 0. Two subjects in the sufladoxine-pyrimethamine group also had P. falciparum infections on day 0; the parasitaemia was cleared on day 2 in one of these subjects and on day 3 in the other, but an early RI response (recrudescence) was observed in the former case. Relapses due to P. vivax occurred in both groups.Side-effects due to Fansimef included mild dizziness, nausea, and vomiting. The incidence of dizziness and nausea was similar in the sulfadoxine-pyrimethamine group. In both groups, these side-effects were mild, short-lived and did not require specific treatment. Thus, Fansimef in an oral dose of three tablets (total of 750 mg mefloquine (base) plus 1500 mg sulfadoxine plus 75 mg pyrimethamine) was found to be well tolerated and safe.

An open, randomized, phase III clinical trial of mefloquine and of quinine plus sulfadoxine-pyrimethamine in the treatment of symptomatic falciparum malaria in Brazil

The clinical and parasitological response of adult male patients to mefloquine and to a combination of quinine and sulfadoxine-pyrimethamine during the treatment of falciparum malaria was compared. These patients were from an area in Brazil where Plasmodium falciparum is showing increasing resistance to quinine and to sulfadoxine-pyrimethamine. The drugs were administered to 100 patients (50 in each group), based on a randomized study design.The rates of clearance of parasitaemia and fever were similar in both groups. However, the parasitological cure rate ("S" response) was 100% for mefloquine but only 92% for quinine plus sulfadoxine-pyrimethamine. Tolerance was good in both groups. The main side-effects (nausea, vomiting, abdominal pain, and dizziness) were mild, transient and required no specific treatment. Nausea and vomiting were more frequent in patients who received quinine plus sulfadoxine-pyrimethamine, while abdominal pain and loose stools or mild diarrhoea were more frequent in the mefloquine group. Tinnitus and hearing difficulty were observed following the administration of quinine plus sulfadoxine-pyrimethamine, but not after mefloquine treatment. Laboratory tests of various haematological and biochemical parameters were not adversely affected in either group after drug administration.It can be concluded that mefloquine, given in a single oral dose of 1000 mg, is highly effective, well tolerated, and safe for the treatment of falciparum malaria in adult males in Brazil.